Non-Recurrent Laryngeal Nerve and Aberrant Vasculature

Clifford, Anthony; Head, Sydney W.

doi:10.5171/2013.224147

Cited by 3 publications

(5 citation statements)

References 6 publications

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“…The location and abnormal placement of the recurrent laryngeal nerve could be of crucial importance during a thyroid surgery as reported in human medicine (Sagayaraj et al., 2015, Bakalinis et al., 2018). Although the incidence of a non‐RLN in human medicine is <1%, the association with concurrent vascular variation amongst the great vessels is well documented (Bakalinis et al., 2018; Henry et al., 2017; Low & Clifford, 2013). Aberrant right subclavian artery (ARSA) occurs in 97% of cases with a right non‐RLN whilst vascular variants occur much less frequently on the left (2.3% of cases) (Bakalinis et al., 2018).…”

Section: Discussionmentioning

confidence: 99%

Anomalous branching of the aortic arch in a dog

Wyatt

Rutllant

2022

Anat Histol Embryol

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Anomalies in the subclavian and common carotid arteries can be of interest in cases of cranial mediastinal surgeries, as well as to diagnose the cause of oesophageal constrictions leading to clinical signs of dysphagia (dysphagia lusoria). The development and regression of the aortic arches are of key importance in understanding the origin of these type of vascular anomalies. This report describes the congenital anomalous aortic origin of the common carotid and the subclavian arteries in a 14-year-old dog and the plausible developmental pattern failure. Academic dissection revealed a common bicarotid trunk and bisubclavian trunk arising from the most cranial aspect of the aortic arch. Despite the abnormal origin, these vessels displayed a predominantly standard anatomical course. All the anticipated branches were identified and described. Cardiac abnormalities were also noted including right atrial dilation, coronary sinus enlargement, right and left valvular endocardiosis, a patent foramen ovale and marked concentric left ventricular hypertrophy with compensatory left atrial dilation. Additionally, the right recurrent laryngeal nerve demonstrated an aberrant course consistent with a 'non-recurrent laryngeal nerve' (non-RLN). Awareness of the anatomical variations of the aortic arch is important for surgical interventions of the cranial mediastinum as well as radiological interpretation. Although infrequent, the variants similar to the one described here have been reported in different species.

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Section: Discussionmentioning

confidence: 99%

Anomalous branching of the aortic arch in a dog

Wyatt

Rutllant

2022

Anat Histol Embryol

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“…С появлением компьютерной томографии (КТ) и рутинным её использованием специалистами различного профиля стало понятно, что подобный вариант развития сосудов в популяции встречается чаще, нежели предполагалось ранее. По некоторым данным аберрантная правая подключичная артерия («загадочная артерия», arteria lusoria -AL) выявляется у 6% населения, что опять же коррелирует с данными по распространенности НВГН полученными в исследованиях на трупах [9,12,13]. Использование на дооперационном этапе эффективного метода диагностики аномалии сосудистого русла может уменьшить время поиска НВГН, предотвратить его повреждения, а, следовательно, и число парезов гортани.…”

Section: обоснованиеunclassified

“…Более редкими локализациями артерии считаются в промежутке между трахеей и пищеводом (15%), впереди трахеи (5%). В большинстве случаев аномалия бессимптомна и только у 5-10% людей может проявляться дисфагией («загадочная дисфагия») [6,[12][13][14]. В наших наблюдениях все выявленные AL (4 случая) располагались позади пищевода.…”

Section: обсуждение основного результата исследованияunclassified

Possibilities of preoperative ultrasound of neck vessels in the diagnosis of non-recurrent laryngeal nerve

Куприн¹,

Malyuga²

2020

Endo Serg

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Background: According to the anatomical data, the non-recurrent laryngeal nerve is a rather common abnormality and can be found in 4.78% of people. At the same time, the non-recurrent laryngeal nerve is difficult to visualize during surgery, which increases the risk of its damage. Aim: to determine the possibilities of ultrasound of neck vessels in the preoperative diagnosis of the aberrant right subclavian artery (arteria lusoria) and the abnormality of the branches of the vagus nerve. Materials and methods: An observational, single-center, single-stage, randomized, uncontrolled clinical trial was performed, which included patients in whom surgery was performed due to thyroid and parathyroid pathology. In the preoperative period, all patients underwent the ultrasound of the right half of the neck vessels and the mediastinum with visualization of the brachiocephalic trunk and its branches. When the brachiocephalic trunk was detected in the preoperative period, mobilization of the thyroid gland during operation was started with ligation of the upper pole vessels, and followed by a search for the recurrent laryngeal nerve. However, if the brachiocephalic trunk was absent, the right common carotid artery was traced as low as possible to the aortic arch and assessed on its relationship with the right subclavian artery. In such cases, thyroid mobilization was started from the lateral surface of the lobe with the necessary visualization of all structures of this region and followed by a primary search for the inferior laryngeal nerve. When the non-recurrent laryngeal nerve was detected, the computed tomography of the brachiocephalic arteries was performed in the postoperative period. Results: The study has shown that 202 (95.28%) patients out of the total 212 revealed the brachiocephalic trunk on preoperative ultrasound and the recurrent laryngeal nerve was located in a the typical place. Arteria lusoria was detected in 4 (1.89%) cases after the preoperative ultrasound. In this group of patients the non-recurrent laryngeal nerve was identified during operation and the aberrant right subclavian artery was confirmed at computed tomography. In 6 (2.83%) cases the brachiocephalic trunk could not be detected on ultrasound due to the constitutional features of the patient. However, in all these cases, the typical recurrent laryngeal nerve was identified during a surgery. Conclusions: The ultrasound of the neck vessels is the effective method to detect arteria lusoria, which is the predictor of the non-recurrent laryngeal nerve.

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“…за собой нижний гортанный нерв [4,11]. Аномалия развития правой подключичной артерии в общей популяции встречается с частотой от 0,1 до 6% [12,15,16], что кор-релирует с распространенностью НВГН на трупах (до 4,8%).…”

Section: клиническое наблюдениеunclassified

“…В большинстве случаев эта аномалия бес-симптомна. Однако в 5-10% она может про-являться дисфагией (загадочная дисфагия) [4,11,12,16].…”

Section: клиническое наблюдениеunclassified

Extralaryngeal variants of the location of the recurrent laryngeal nerve. Clinical observation in thyroid surgery

Malyuga¹,

Александрович²

2017

Endo Serg

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Возвратный гортанный нерв может иметь множество анатомических вариантов при экстраларингеальном расположении, что нередко приводит к смене техники оперативного вмешательства в каждом конкретном случае. В статье описаны два клинических наблюдения выявления невозвращающегося возвратного гортанного нерва и дополнительных коллатеральных анастомозирующих структур возвратного гортанного нерва. Невозвращающий-ся возвратный гортанный нерв, по данным последних исследований, встречается в общей популяции несколько чаще (до 4,8%), чем может предположить практикующий хирург-эндокринолог. Выявление невозвращающегося возвратного гортанного нерва перед операцией является важным объектом исследований. По данным многих авторов, парезы гортани при невозвращающемся возвратном гортанном нерве увеличиваются в разы по сравнению с возвращающимся гортанным нервом. Функциональное и клиническое значение анастомозирующих структур возвратного гортанного нерва до сих пор остается неизвестным. Визуализация их во время операции -редкое явление. Это приводит к их неизбежному повреждению. Таким образом, альтернативой теории тракционных повреждений возвратного гортанного нерва мы видим повреждение его нестандартных анатомических вариантов и анастомозирующих структур. В связи с редкостью выявления таких вариантов экстраларингеального расположения возвратного гортанного нерва считаем целесообразным поделиться собственным опытом. Ключевые слова: невозвращающийся возвратный гортанный нерв, анастомоз Галена, симпатическая анастомозирующая ветвь нижнего гортанного нерва, клиническое наблюдение.The recurrent laryngeal nerve can have a variety of options in extralaryngeal position, which often changes the technique of surgical intervention in each specific case. Below there are two clinical observations of the non-recurrent laryngeal nerve and additional collateral anastomosing structures of the recurrent laryngeal nerve. The non-recurrent laryngeal nerve, according to the recent research, is found in the general population somewhat more often (up to 4.8%) than the practicing surgeon may suggest. The identification of a non-recurrent laryngeal nerve before surgery is an important object of research. According to many authors, the cord palsy in the non-recurrent laryngeal nerve increases many times compared with the recurrent laryngeal nerve. The functional and clinical significance of the anastomosing structures of the recurrent laryngeal nerve is still unknown. To visualize them during surgery is a rare phenomenon, which ultimately leads to their damage. Thus, an alternative to the theory of traction damage of the recurrent laryngeal nerve is the damage to its non-standard anatomical variants and anastomosing structures. Taking into account that such an option of extralaryngeal location of the recurrent laryngeal nerve is so rare, we consider it appropriate to share our own experience.

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Non-Recurrent Laryngeal Nerve and Aberrant Vasculature

Abstract: Background: The incidence of non-recurrent laryngeal (RLN) nerve is around 0.5%. Injury to the nerve results in significant morbidity.

Cited by 3 publications

References 6 publications

Anomalous branching of the aortic arch in a dog

Anomalous branching of the aortic arch in a dog

Possibilities of preoperative ultrasound of neck vessels in the diagnosis of non-recurrent laryngeal nerve

Extralaryngeal variants of the location of the recurrent laryngeal nerve. Clinical observation in thyroid surgery

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